Chan Grace W, Mandel Susan J
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Nat Clin Pract Endocrinol Metab. 2007 Jun;3(6):470-8. doi: 10.1038/ncpendmet0508.
The diagnosis of Graves' disease in pregnancy can be complex because of normal gravid physiologic changes in thyroid hormone metabolism. Mothers with active Graves' disease should be treated with antithyroid drugs, which impact both maternal and fetal thyroid function. Optimally, the lowest possible dose should be used to maintain maternal free thyroxine levels at or just above the upper limit of the normal nonpregnant reference range. Fetal thyroid function depends on the balance between the transplacental passage of thyroid-stimulating maternal antibodies and thyroid-inhibiting antithyroid drugs. Elevated levels of serum maternal anti-TSH-receptor antibodies early in the third trimester are a risk factor for fetal hyperthyroidism and should prompt evaluation of the fetal thyroid by ultrasound, even in women with previously ablated Graves' disease. Maternal antithyroid medication can be modulated to treat fetal hyperthyroidism. Serum TSH and either total or free thyroxine levels should be measured in fetal cord blood at delivery in women with active Graves' disease, and those with a history of (131)I-mediated thyroid ablation or thyroidectomy who have anti-TSH-receptor antibodies. Neonatal thyrotoxicosis can occur in the first few days of life after clearance of maternal antithyroid drug, and can last for several months, until maternal antibodies are also cleared.
由于孕期甲状腺激素代谢存在正常的生理变化，妊娠期格雷夫斯病的诊断可能会很复杂。患有活动性格雷夫斯病的母亲应使用抗甲状腺药物治疗，这些药物会影响母体和胎儿的甲状腺功能。最佳做法是，应使用尽可能低的剂量，以将母体游离甲状腺素水平维持在非孕期正常参考范围上限或略高于该上限。胎儿的甲状腺功能取决于母体刺激甲状腺抗体经胎盘传递与抑制甲状腺的抗甲状腺药物之间的平衡。孕晚期早期母体血清抗促甲状腺激素受体抗体水平升高是胎儿甲状腺功能亢进的一个危险因素，即使是既往已行格雷夫斯病消融治疗的女性，也应通过超声对胎儿甲状腺进行评估。可调整母体抗甲状腺药物的剂量来治疗胎儿甲状腺功能亢进。对于患有活动性格雷夫斯病的女性，以及有碘-131介导的甲状腺消融或甲状腺切除术病史且有抗促甲状腺激素受体抗体的女性，分娩时应检测胎儿脐带血中的血清促甲状腺激素以及总甲状腺素或游离甲状腺素水平。新生儿甲状腺毒症可在母体抗甲状腺药物清除后的出生后几天内发生，并可持续数月，直至母体抗体也被清除。
